What is infertility?
Last week we looked at how the discovery of infertility and the process of fertility treatments impacts on mental health. This week, we are flipping this on it's head and looking at the impact of mental health on fertility.
Just as a little reminder; the official definition of infertility is 'the failure to conceive after regular, unprotected sexual intercourse over 1-2 years.' By regular intercourse, they mean 2-3 times per week.
How could mental health impact infertility?
There are studies to show that mental health an infertility are linked together, however there is nothing definitive just yet. For example, studies have shown that the incidences of depression and anxiety in infertile couples is significantly higher than in fertile couples. However, it is possible that there are further factors that haven't been considered here. For example, it is very possible that the anxiety and depression result from trying to get pregnant, without success, for some time.
Another study (by Lapane et al, 1995) showed a 2-fold increase in the risk of infertility among women with a history of depressive symptoms. However, what the study didn't take into account was other contributory factors, which happen to also be increased in depression, such as low libido, smoking, and alcohol use.
The Biological Side
One theory about how depression could impact fertility lies in the physiology of the depressive state. Namely, the increase in prolactin level, the disruption to the hypothalamic-pituitary-adrenal axis (HPA axis), and thyroid dysfunction.
Prolactin is a hormone released by the anterior pituitary gland that stimulates milk production after birth. High levels of prolactin are normal during pregnancy and after birth, however hyperprolactinemia (elevated levels of prolactin) can interrupt the normal production of estrogen and progesterone. This can cause the ovaries to either stop producing eggs altogether or the release eggs irregularly.
Hyperprolactinemia can be caused by anorexia nervosa, liver disease, kidney disease, and hypothyroidism. It can also be induced by certain medications including risperidone and haloperidol (which are psychiatric drugs) and anti-nausea drugs used in the treatment of cancer.
The HPA axis governs the cardiovascular and metabolic systems in the body, as well as immune function, behaviour, and reproduction. Activation of the HPA axis, by various stressors, can inhibit reproductive function and can impact fetal development. The HPA axis is most often activated during the 'fight or flight' response to stressors.
Finally, undiagnosed thyroid dysfunction can make it difficult to conceive and can cause problems during the pregnancy, however once the over- or under-active thyroid is under control, there is no reason that you shouldn't have a healthy pregnancy.
What does this mean?
As I mentioned earlier in this article, there is no definitive proof that mental health issues such as stress, anxiety, or depression specifically cause infertility. It is likely that they do not help exisiting fertility issues, but nothing says that they cause these issues.
Further studies are needed to distinguish the direct effects of depression and anxiety from the associated behaviours such as low libido, smoking, and drinking.
As always, if you would like to book an initial counselling session with me, please email me at firstname.lastname@example.org
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